Wiki Can G2211 be billed by providers other than the patient's Primary Care Provider?

[davidinasheville]

I am in a Primary Care Practice with many providers. Full rules for using G2211 have not been published, so far as I can find. I can bill G2211 if I see the patient for an acute issue rather than a chronic issue. I would like to hear that Medicare allows an APP or another physician to bill G2211 if they see my patient for an urgent issue or followup. Does anyone know whether the other providers in the practice can "stand in" in this way for me? Or can only the official PCP bill this code? Thanks in advance.

Palmetto GBA gives this advice:

Example 1: A patient sees you, their primary care practitioner, for sinus congestion. You may suggest conservative treatment or antibiotics for a sinus infection. You decide on the course of action and the best way to communicate the recommendations to the patient in the visit. How the recommendations are communicated is important in that it not only affects the patient’s health outcomes for this visit, but it also can help build an effective and trusting longitudinal relationship between you and the patient. This is key so you can continue to help them meet their primary health care needs. The complexity that code G2211 captures isn’t in the clinical condition – the sinus congestion. The complexity is in the cognitive load of the continued responsibility of being the focal point for all needed services for this patient. There’s important cognitive effort of using the longitudinal doctor-patient relationship itself in the diagnosis and treatment plan. These factors, even for a simple condition like sinus congestion, make the entire interaction inherently complex. In this example, you may bill G2211.

 

[csperoni]

My current interpretation of G2211 is that it is possibly appropriate for an acute problem if you are ALSO managing the longitudinal/ongoing relationship.
So, Dr. A is the PCP. Patient fell off a step and sees Dr. B or PA1 since Dr. A is off today.
If during the visit for her ankle, Dr. B or PA1 also address some of her ongoing care (renew metformin, order a cholesterol test to evaluate Lipitor, remind her she's overdue for colonoscopy and give her a local GI, ask her how she's doing on the new prescription Dr. A wrote last visit), then G2211 would be appropriate. If Dr. B or PA1 simply order an xray and tell her to take ibuprofen 600mg, there is no "cognitive effort" to justify G2211.
As additional coding advice for G2211 comes out, my opinion could change, but as of today, this is where I stand.

 

[jkyles]

I am in a Primary Care Practice with many providers. Full rules for using G2211 have not been published, so far as I can find. I can bill G2211 if I see the patient for an acute issue rather than a chronic issue. I would like to hear that Medicare allows an APP or another physician to bill G2211 if they see my patient for an urgent issue or followup. Does anyone know whether the other providers in the practice can "stand in" in this way for me? Or can only the official PCP bill this code? Thanks in advance.

Palmetto GBA gives this advice:

Example 1: A patient sees you, their primary care practitioner, for sinus congestion. You may suggest conservative treatment or antibiotics for a sinus infection. You decide on the course of action and the best way to communicate the recommendations to the patient in the visit. How the recommendations are communicated is important in that it not only affects the patient’s health outcomes for this visit, but it also can help build an effective and trusting longitudinal relationship between you and the patient. This is key so you can continue to help them meet their primary health care needs. The complexity that code G2211 captures isn’t in the clinical condition – the sinus congestion. The complexity is in the cognitive load of the continued responsibility of being the focal point for all needed services for this patient. There’s important cognitive effort of using the longitudinal doctor-patient relationship itself in the diagnosis and treatment plan. These factors, even for a simple condition like sinus congestion, make the entire interaction inherently complex. In this example, you may bill G2211.

Hi there, someone asked a similar question during CMS' open door forum last week. According to the CMS official, the answer is yes. Providers at the same practice/specialty can bill for G2211 when they can stand in for one another, assuming the visit and their documentation meets the requirements for the code. What CMS expects to see is evidence of the ongoing patient/provider relationship. Personal opinion: Where I would say this would not work is if the patient only comes in when they have an acute problem and their "usual" provider doesn't have any insight (or input) into the patient's care in between.